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Knee surgeries like RGIII's are on the rise

Griffin had surgery Wednesday morning to repair the lateral collateral ligament in his right knee and to explore the damage to his anterior cruciate ligament.

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Kevin A. Kepple, Bob Laird and Anne R. Carey, USA TODAY

Janice Lloyd, USA TODAY
11:20 a.m. EST January 11, 2013

The number of anterior cruciate ligament injuries has more than tripled since 2000.

Redskins quarterback Robert Griffin III mishandles the snap from center and can't pick up the ball during the fourth quarter of their NFL playoff football game against the Seahawks on Sunday in Landover, Md. Griffin left the game with an injury to his right knee.(Photo: Richard Lipski, AP)

Story Highlights

Redskins' Robert Griffin III tore his ACL

ACL injuries are the most common type of knee sprain

Young female athletes are more at risk of damaging the ACL than males

Confident you and your teen athlete are both safe from suffering the knee injury that forced NFL quarterback Robert Griffin III off the game field and under the knife this week?

Think again. The Washington Redskins' rookie tore two of the four primary ligaments, including his anterior cruciate ligament (ACL). The number of ACL injuries has more than tripled since 2000, according to the American Academy of Orthopedic Surgeons, and it doesn't take a hit from a behemoth defenseman to cause it. ACL injuries are the most common type of knee sprain and they result more frequently from non-contact.

"It can happen in any sport that requires you to pivot, turn, twist or jump,'' says Jim Thornton, president of the National Athletic Trainers' Association. "It can even happen on a golf course on uneven terrain or if you're working in your yard."

Learning how to protect the knee can eliminate the need for surgery and can help prevent lingering damage that can cause arthritis and lead to knee replacements. Knee replacement surgeries are also soaring and are expected to continue to rise as active Baby Boomers age.

Thornton says strengthening the core and hips helps and proper warm-ups can help prevent the ACL tears.

Braces, like the one worn by Griffin during the game, can support the ligaments on the outside and inside of knees, but will not aid the ACL. That rope-like ligament is in the center of the knee and runs diagonally from the thigh bone to the shin bone.

If walking, jogging, cycling or swimming is your game, you can probably skip surgery, he says. But if you want to do anything other than move in a straight line, it's probably time to find a good surgeon. While the other knee ligaments might heal on their own, the ACL is unlikely to do so, because it has poor blood circulation.

"I have so many parents ask me, 'If this were your child, would you go through with the surgery?' '' says Fred Azar, vice president of the American Academy of Orthopedic Surgeons and an orthopedic surgeon in Memphis. "I always tell them: I have two teenagers and, yes, I'd get the surgery for them. It's too hard to return to your normal level of activity without an intact ACL.''

Young female athletes are more at risk of damaging the ACL than males when they compete in similar sports, suggests research by the National Athletic Trainers' Association and the National Institutes of Health. Among the 989,619 patients who visited doctors with ACL injuries in 2010 (the most recent numbers available), about one in four were females, according to the orthopedic surgeons group. More men play sports than women, so the numbers don't tell the whole story.

Azar says ACL surgery requires attaching a graft from another part of the body or from a cadaver, followed by a long rehab, normally about six months. He was not involved in Griffin's treatment, but he says his rehab this time will take longer.

"RGIII had ACL surgery in 2009 on the same knee,'' he says. "A second surgery can take eight to 12 months to heal, because it's a more complicated surgery,'' Azar says.

One possible upside to surgery? Grafting a tendon that is thicker than the damaged ACL can give the athlete a "greater sense of stability. Some say they like it better, but it does take awhile to get used to it," Azar says.

A tear is often diagnosed during an MRI, but surgeons don't know the extent of the injury until they examine the inside of the knee.

Other signs of a torn ACL:

-- A popping noise

-- Kneecap can look out of place compared to the other knee

-- Bruising and swelling can occur, but some people don't feel much pain.

-- Difficulty bending the knee.

After rehab, Thornton says, only a physician should give clearance for a player to return to the playing field. A national debate ensued over whether Griffin had returned to play too soon after injuring his other ligament several weeks before.

"Sometimes these injuries just happen,'' Thornton says. "Had he stayed out longer to let the other injury heal, maybe it wouldn't have happened, but it's hard to know."

In either case, Thornton says, parents don't want coaches or student athletes to make the decision about when to return to action.

"When there's a win on the line, they don't always have the health of the athlete in mind,'' he says.